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Identification of patients at risk for colorectal cancer in primary care: an explorative study with routine healthcare data

Koning, Nynke R.a,d; Moons, Leon M.G.b; Büchner, Frederike L.a,d; Helsper, Charles W.a; ten Teije, Annettec; Numans, Mattijs E.a,d

European Journal of Gastroenterology & Hepatology: December 2015 - Volume 27 - Issue 12 - p 1443–1448
doi: 10.1097/MEG.0000000000000472
Original Articles: Colorectal Cancer

Background Early diagnosis of colorectal cancer (CRC) is likely to reduce burden of disease and improve treatment success. Estimation of the individual patient risk for CRC diagnostic determinants in a primary care setting has not been very successful as yet. The aim of our study is to improve prediction of CRC in patients selected for colonoscopy in the primary healthcare setting using readily available routine healthcare data.

Patients and methods A cross-sectional study was carried out in the Julius General Practitioners’ Network database. Patients referred for colonoscopy by their general practitioner (GP) between 2007 and 2012 were selected. We evaluated the association between long-term registered patient characteristics, symptoms and conditions, and colonoscopy test results with multivariable logistic regression.

Results Two per cent (2787/140 000) of the patients between 30 and 85 years were found to be newly referred for colonoscopy by their GP, of whom 57 (2%) were diagnosed with CRC. Age 50 years or over, hypertension and the absence of preceding consultations for abdominal pain were independent predictors for CRC and/or high-risk adenomas, with an area under the curve of 0.65.

Conclusion Three factors in routine care data combined might prove valuable in future strategies to improve the prediction of CRC risk in primary care. Improvement in quality and availability of routine care data for research and risk stratification is needed to optimize its usability for prediction purposes in daily practice.

Impact Only referring patients at the highest risk for colonoscopy by the GP could decrease superfluous colonoscopies.

aJulius Center for Health Sciences and Primary Care

bDepartment of Gastroenterology, University Medical Center Utrecht, Utrecht

cDepartment of Computer Science, VU University Amsterdam, Amsterdam

dDepartment of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands

Correspondence to Frederike L. Büchner, PhD, Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands Tel: +31 71 526 8446; fax: +31 71 526 8259; e-mail:

Received May 29, 2015

Accepted August 10, 2015

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.